OPEN-WEDGE PROXIMAL TIBIAL OSTEOTOMY USING AN INTRAMEDULLARY TIBIAL NAIL

Abstract

Introduction: This study reports a technique and result in the application of an intramedullary tibial nail for patients undergoing an open-wedge proximal tibial osteotomy.

Materials and Methods: Fourteen knees of 10 patients with genu varum were treated with proximal tibial osteotomy using an intramedullary tibial nail. The average age at the time of operation was 25 years old. Tibial osteotomy was performed percutaneously through multiple drilling from the average 8.7cm below the joint line and no bone graft was performed in all cases. Concomitant fibular osteotomy was performed in 9 cases. The clinical and radiographic records were reviewed for a minimum 2 years follow up.

Result: Union of the osteotomy site was obtained in all knees at a mean of 3.5 months in both anteroposterior and lateral radiographs. The mean postoperative correction angle was 11 degrees in femorotibial angle in frontal plane (P< 0.05). But significant change of tibial posterior slope was not determined (P> 0.05). The osteotomized tibia was lengthened average 6mm in postoperative anteropsterior radiograph. Range of motion of the knee was full at the latest follow up. There was no significant complication such as infection, deep venous thrombosis, nerve palsy, or implant failure.

Conclusion: Open-wedge proximal tibial osteotomy using an intramedullary tibial nail for genu varum provides firm initial stability and early rehabilitation. Furthermore, there is no need of bone graft and no significant alteration in tibial slope after surgery. Thus this technique can be a viable option for the proximal tibial osteotomy in the treatment for genu varus.